| NPI | 1578914891 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATTHEW F COSTELLO Senior Executive Director 267-885-4335 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical |
| Enumeration Date | 2016-06-28 |
| Last Update Date | 2023-08-24 |